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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700408
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:36:31 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/01/2024 01:36 PM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
HOME CARE SERVICES, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:TRUSTED CAREGIVER AND CONSULTING SERVICES, LLCFACILITY NUMBER:
194700408
ADMINISTRATOR/
DIRECTOR:		ASIS, EMELYNFACILITY TYPE:
300
ADDRESS:18327 GRIDLEY AVE. SUITE ETELEPHONE:
(562) 275-2670
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: CENSUS: DATE:
05/01/2024
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:10 PM
MET WITH:Emelyn Asis, LicenseeTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
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On May 1, 2024, Associate Governmental Program Analysts (AGPA) Joshua Rarela and Adrian Mangina with Home Care Services Bureau arrived at the Home Care Organization (HCO) listed above. Upon arrival, the AGPAs identified themselves and was greeted by the HCO representative named above.

The HCO license was posted, but there was no posting on the hours of operation. The AGPAs were then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review, the AGPAs discussed the findings of the inspection with the licensee. The licensee posted the HCO business hours during the inspection.

The AGPAs informed the licensee of the deficiency found and explained it would be noted on the HCS809D. In addition, the licensee was provided a copy of the LIC 9058 (Applicant/Licensee Rights) form.
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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Document Has Been Signed on 05/01/2024 01:36 PM - It Cannot Be Edited


Created By: Joshua Rarela On 05/01/2024 at 01:01 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814

FACILITY NAME: TRUSTED CAREGIVER AND CONSULTING SERVICES, LLC
FACILITY NUMBER: 194700408

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
1796.42(a)
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A home care organization licensee shall do all of the following: (a) Post its license, business hours, and any other information required by the department in its place of business in a conspicuous location, visible both to clients and affiliated home care aides.
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The requirement is not met as evidenced by:

During the unannounced inspection, it was observed that there was no posted business hours for the Home Care Organization (HCO), a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
LICENSING EVALUATOR NAME: Joshua Rarela
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
LIC809 (FAS) - (06/04)
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